Summary This project is directed towards transforming the blood donor pool in Ghana from family replacement donations (FRD) to voluntary collections. In line with WHO recommendations, the national blood policy in Ghana aims at 100% voluntary blood donation pool to secure and sustain an adequate and safe blood supply, since voluntary blood donors are more likely to donate on a regular basis. The major challenge for blood transfusion services in sub-Saharan Africa (SSA) is the juxtaposition of an increasing clinical demand for blood and a historically insufficient supply of safe blood in the region. The inadequate and irregular supply of blood readily available for emergency transfusions play a cardinal role in the high mortality rates in obstetric haemorrhage. We have identified the system of blood donation in Ghana as the major barrier to providing adequate and regular blood to meet the transfusion needs of the country. Currently, over 70% of blood collection in Ghana is obtained in a Family Replacement Donor (FRD) system, which is associated with insufficient, unsustainable and relatively unsafe supply of blood for emergencies. In contrast with an average rate of 31 per 1000 population in countries with a 100% voluntary blood donor base, blood donation in Ghana remains at only 5 per 1000 population. As a direct result, blood supply is characterized by chronic inadequacy with frequent critical shortages, and represents a major developmental challenge. Our long-term goal is to secure a sustainable supply of adequate and safe blood in Ghana by establishing a new paradigm of blood donation in the country focused on a community-based volunteer system and nutritional donor enrichment. Anaemia accounts for up to 53% of voluntary donor deferrals and is, therefore, a major focus of the current application. In addition, fears associated with misconceptions about blood donation, and the lack of knowledge and information on blood donation contribute to the low number of blood donation volunteers in Ghana. The targeting of communities to donate blood not as individuals but as communities (communal collectivism), with a reciprocity model that ensures blood is available for future use by their own communities offers an attractive strategy to recruit new volunteers. Interventions based on communal collectivism and aided by communication strategies are culturally appropriate in SSA but have not yet been explored for increasing blood donation rates. Additionally, other modifiable causes of inadequate blood donation?motivation, access to donation facilities, nutrition?will be targeted using improved communication, behavioural change methods, and iron supplementation to improve overall donor recruitment and retention. We will evaluate the impact of increased availability of volunteer community-sourced blood on reduction of haemorrhage-related maternal deaths in community hospitals. Based on these ideas, we will test the OVERALL HYPOTHESIS ?A community-based volunteer and nutritional donor enrichment model towards recurring blood donors will help to overcome the developmental challenge of blood availability in Ghana?.